Peptic Ulcer Disease
Peptic ulcer disease (PUD) involves damage (ulcers) to the lining of different parts of the digestive system. The most common types of PUD are gastric ulcers (GU) and duodenal ulcers (DU). About 10% of people will develop a peptic ulcer.
The most common cause of gastric and duodenal ulcers is a spiral-shaped, gram-negative bacterium – genus: Helicobacter, species: pylori – that lives on the gastric mucosa under the mucous layer. This organism was first observed in stomach biopsy specimens by Australian pathologist J.
Peptic ulcer disease refers to a group of ulcerative disorders of the upper gastrointestinal tract that require acid and pepsin for their formation. Ulcers differ from gastritis and erosions in that they extend deeper into the muscularis mucosa.
Nearly 60 million Americans experience symptoms of gastroesophageal reflux disease (GERD). A class of drugs called “proton pump inhibitors” (PPIs), introduced in the late 1980s, has vastly improved the treatment of GERD. Check the latest information about Nexium (Esomeprazole magnesium).
The classic symptoms of peptic ulcer disease – epigastric burning pain on an empty stomach that is relieved by food or antacids – are familiar to most physicians and lay people. Sometimes the pain radiates to the back, suggesting an ulcer of the posterior aspect of the duodenal bulb that may have penetrated into the pancreas.
The most common cause of peptic ulcer disease is a bacterium designated Helicobacter pylori that was first observed in gastric biopsy specimens in 1979 and has since been identified in every human population tested on six continents. The spiral- shaped, gram-negative bacterium causes acute and chronic gastritis, gastric ulcers, duodenal ulcers, gastric cancer, and a type of lymphoma; it is the most common single cause of infectious disease in the world. (See Helicobacter pylori and Ulcers a comprehensive review of H. pylori.) Last month the FDA approved two new combination drug products for the treatment of peptic ulcers: Glaxo Wellcome’s ranitidine bismuth citrate (Tritec) and Proctor & Gamble’s (P&G) bismuth subsalicylate plus tetracycline and metronidazole (Helidac). Ranitidine bismuth citrate (RBC, Tritec / Glaxo) was approved for use in combination with clarithromycin (Biaxin / Abbott) for the treatment of active duodenal ulcer disease associated with H. pylori infection.
Duodenal ulcer (DU): Most located in the duodenal bulb. Multiple ulcers, and if distal to the bulb raise the possibility of Zollinger-Ellison syndrome.
Prostaglandin analogs, (e.g., misoprostol (Cytotec)) have been used to treat peptic conditions in clinical trials and appear to be as effective as H2 antagonists in healing ulcers when administered in doses that inhibit acid secretion. However, there is little evidence that synthetic prostaglandins are clinically effective when given in the lower, purely cytoprotective doses that have no effect on acid secretion. Whether the synthetic prostaglandins offer any practical advantages over current therapy is debatable, although one analog that is commercially available, misoprostol, appears to be useful in the prevention and treatment of nonsteroidal antiinflammatory drug-induced gastric ulcers or erosions.